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2.
J Plast Reconstr Aesthet Surg ; 73(12): 2136-2141, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1023481

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic presented unprecedented challenges for healthcare systems worldwide. The Queen Elizabeth Hospital, Birmingham, has one of the largest burns, hands and plastics department in the UK, totalling 83 doctors. Our response to the COVID-19 response was uniquely far reaching, with our department being given responsibility of an entire 36 bed medical COVID-19 ward in addition to our commitment to specialty-specific work, and saw half of our work force re-deployed to Intensive Treatment Unit (ITU). Our aim was to exploit the high calibre of doctors found in plastic surgery, and to demonstrate, we were able to support the COVID-19 effort beyond our normal scope of practice. In order to achieve this aim, the department underwent significant structural and leadership changes. Factors considered included: rota and shift pattern changes to implement depth and resilience to sudden fluctuations in staffing levels; a preparatory phase for focussed upskilling and relevant training packages to be delivered; managing the COVID-19 ward cover and ITU deployment; adjustments to our front of house and elective specialty-specific service, including developing alternative and streamlined patient pathways; mitigating the effects on plastic surgical training during the pandemic; the importance of communications for patient care and physician wellbeing; and leadership techniques and styles we considered important. By sharing our experience during this pandemic, we hope to reflect on and share lessons learned, as well as to demonstrate that it is possible to rapidly mobilise and retrain plastic surgeons at all levels to contribute safely and productively beyond a specialty-specific scope of care.


Subject(s)
/epidemiology , Pandemics , Reconstructive Surgical Procedures , Surgery Department, Hospital/organization & administration , Computer-Assisted Instruction , Critical Pathways , Elective Surgical Procedures , Humans , Infection Control , Intensive Care Units/organization & administration , Interdisciplinary Communication , Leadership , Personnel Staffing and Scheduling , Surgery, Plastic/education , United Kingdom/epidemiology
3.
Chirurgia (Bucur) ; 115(6): 715-725, 2020.
Article in English | MEDLINE | ID: covidwho-1000769

ABSTRACT

Introduction: SARS-CoV-2 is a Betacoronavirus belonging to the Sarbecovirus subgenus of the Coronavidae family, antigenically distinct from SARS CoV, with which it has a genetic similarity of about 76% of nucleotides (1). It causes the Covid-19 disease in humans, which mainly affects the respiratory system, through inflammatory and procoagulant mechanisms at the level of alveolar microcirculation. Material and method: There are 145 patients infected with SARS-CoV-2, treated in the Colentina Surgery Clinic during March-August 2020, whose cases were analysed to identify some elements that would help to improve the medical management of these patients from multiple perspectives. Discussion: There was a slight predominance of male impairments, and the ages of interest were mostly over 60 years. The cases that required surgery were in an absolute minority (14 cases). The operations were performed only in conditions of a surgical emergency. Mortality was high (24,13%).


Subject(s)
/epidemiology , Surgery Department, Hospital/organization & administration , Hospitals , Humans , Male , Middle Aged , Romania , Treatment Outcome
4.
S Afr Med J ; 0(0): 13182, 2020 12 14.
Article in English | MEDLINE | ID: covidwho-984482

ABSTRACT

BACKGROUND: The COVID-19 pandemic has led to the implementation of restrictive policies on theatre procedures, with profound impacts on service delivery and theatre output. OBJECTIVES: To quantify these effects at a tertiary hospital in KwaZulu-Natal Province, South Africa. METHODS: A retrospective review of morbidity and mortality data was conducted. The effects on emergency and elective caseload, intensive care unit (ICU) admissions from theatre, theatre cancellations and regional techniques were noted. RESULTS: Theatre caseload decreased by 30% from January to April 2020 (p=0.02), ICU admissions remained constant, and theatre cancellations were proportionally reduced, as were the absolute number of regional techniques. CONCLUSIONS: The resulting theatre case deficit was 1 260 cases. It will take 315 days to clear this deficit if four additional surgeries are performed per day.


Subject(s)
Elective Surgical Procedures/statistics & numerical data , Infection Control , Surgery Department, Hospital , Tertiary Healthcare , Adult , /prevention & control , Emergency Service, Hospital/organization & administration , Emergency Service, Hospital/statistics & numerical data , Female , Health Policy , Humans , Infection Control/methods , Infection Control/organization & administration , Male , Mortality , Needs Assessment , Organizational Innovation , Safety Management/trends , South Africa/epidemiology , Surgery Department, Hospital/organization & administration , Surgery Department, Hospital/statistics & numerical data , Tertiary Healthcare/organization & administration , Tertiary Healthcare/trends
5.
Infect Control Hosp Epidemiol ; 41(12): 1375-1377, 2020 12.
Article in English | MEDLINE | ID: covidwho-989622

ABSTRACT

OBJECTIVE: Presently, evidence guiding clinicians on the optimal approach to safely screen patients for coronavirus disease 2019 (COVID-19) to a nonemergent hospital procedure is scarce. In this report, we describe our experience in screening for SARS-CoV-2 prior to semiurgent and urgent hospital procedures. DESIGN: Retrospective case series. SETTING: A single tertiary-care medical center. PARTICIPANTS: Our study cohort included patients ≥18 years of age who had semiurgent or urgent hospital procedures or surgeries. METHODS: Overall, 625 patients were screened for SARS-CoV-2 using a combination of phone questionnaire (7 days prior to the anticipated procedure), RT-PCR and chest computed tomography (CT) between March 1, 2020, and April 30, 2020. RESULTS: Of the 625 patients, 520 scans (83.2%) were interpreted as normal; 1 (0.16%) had typical features of COVID-19; 18 scans (2.88%) had indeterminate features of COVID-19; and 86 (13.76%) had atypical features of COVID-19. In total, 640 RT-PCRs were performed, with 1 positive result (0.15%) in a patient with a CT scan that yielded an atypical finding. Of the 18 patients with chest CTs categorized as indeterminate, 5 underwent repeat negative RT-PCR nasopharyngeal swab 1 week after their initial swab. Also, 1 patient with a chest CT categorized as typical had a follow-up repeat negative RT-PCR, indicating that the chest CT was likely a false positive. After surgery, none of the patients developed signs or symptoms suspicious of COVID-19 that would indicate the need for a repeated RT-PCR or CT scan. CONCLUSION: In our experience, chest CT scanning did not prove provide valuable information in detecting asymptomatic cases of SARS-CoV-2 (COVID-19) in our low-prevalence population.


Subject(s)
Infection Control/methods , Pneumonia, Viral/diagnosis , /isolation & purification , Adult , /epidemiology , /methods , Evidence-Based Practice , False Positive Reactions , Female , Humans , Male , Mass Screening/methods , Mass Screening/standards , Minnesota/epidemiology , Pneumonia, Viral/etiology , Safety Management , Surgery Department, Hospital/organization & administration , Tomography, X-Ray Computed/methods , Tomography, X-Ray Computed/standards , Tomography, X-Ray Computed/statistics & numerical data
8.
Ann Surg ; 272(6): e316-e320, 2020 12.
Article in English | MEDLINE | ID: covidwho-975402

ABSTRACT

OBJECTIVE: The outcomes of patients treated on the COVID-minimal pathway were evaluated during a period of surging COVID-19 hospital admissions, to determine the safety of continuing to perform urgent operations during the pandemic. SUMMARY OF BACKGROUND DATA: Crucial treatments were delayed for many patients during the COVID-19 pandemic, over concerns for hospital-acquired COVID-19 infections. To protect cancer patients whose survival depended on timely surgery, a "COVID-minimal pathway" was created. METHODS: Patients who underwent a surgical procedure on the pathway between April and May 2020 were evaluated. The "COVID-minimal surgical pathway" consisted of: (A) evolving best-practices in COVID-19 transmission-reduction, (B) screening patients and staff, (C) preoperative COVID-19 patient testing, (D) isolating pathway patients from COVID-19 patients. Patient status through 2 weeks from discharge was determined as a reflection of hospital-acquired COVID-19 infections. RESULTS: After implementation, pathway screening processes excluded 7 COVID-19-positive people from interacting with pathway (4 staff and 3 patients). Overall, 122 patients underwent 125 procedures on pathway, yielding 83 admissions (42 outpatient procedures). The median age was 64 (56-79) and 57% of patients were female. The most common surgical indications were cancer affecting the uterus, genitourinary tract, colon, lung or head and neck. The median length of admission was 3 days (1-6). Repeat COVID-19 testing performed on 27 patients (all negative), including 9 patients evaluated in an emergency room and 8 readmitted patients. In the postoperative period, no patient developed a COVID-19 infection. CONCLUSIONS: A COVID-minimal pathway comprised of physical space modifications and operational changes may allow urgent cancer treatment to safely continue during the COVID-19 pandemic, even during the surge-phase.


Subject(s)
/prevention & control , Critical Pathways/organization & administration , Cross Infection/prevention & control , Emergency Treatment , Safety Management/organization & administration , Surgery Department, Hospital/organization & administration , Surgical Procedures, Operative , Aged , Female , Humans , Male , Middle Aged
9.
Am Surg ; 86(12): 1629-1635, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-965776

ABSTRACT

BACKGROUND: The role of an acute care surgery (ACS) service during the COVID-19 pandemic is not well established. METHODS: A retrospective review of the ACS service performance in an urban tertiary academic medical center. The study was performed between January and May 2020. The demographics, clinical characteristics, and outcomes of patients treated by the ACS service 2 months prior to the COVID surge (pre-COVID group) and during the first 2 months of the COVID-19 pandemic (surge group) were compared. RESULTS: Trauma and emergency general surgery volumes decreased during the surge by 38% and 57%, respectively; but there was a 64% increase in critically ill patients. The proportion of patients in the Department of Surgery treated by the ACS service increased from 40% pre-COVID to 67% during the surge. The ACS service performed 32% and 57% of all surgical cases in the Department of Surgery during the pre-COVID and surge periods, respectively. The ACS service managed 23% of all critically ill patients in the institution during the surge. Critically ill patients with and without confirmed COVID-19 infection treated by ACS and non-ACS intensive care units during the surge did not differ in demographics, indicators of clinical severity, or hospital mortality:13.4% vs. 13.5% (P = .99) for all critically ill patients; and 13.9% vs. 27.4% (P = .12) for COVID-19 critically ill patients. CONCLUSION: Acute care surgery is an "essential" service during the COVID-19 pandemic, capable of managing critically ill nonsurgical patients while maintaining the provision of trauma and emergent surgical services. LEVEL OF EVIDENCE: III. STUDY TYPE: Therapeutic.


Subject(s)
Critical Care/organization & administration , Emergency Service, Hospital/organization & administration , Surgery Department, Hospital/organization & administration , Academic Medical Centers/organization & administration , Emergency Service, Hospital/statistics & numerical data , Hospitals, Urban/organization & administration , Humans , Pandemics , Retrospective Studies , Surgery Department, Hospital/statistics & numerical data , Tertiary Care Centers/organization & administration , Wounds and Injuries/surgery
10.
BMC Surg ; 20(1): 313, 2020 Dec 03.
Article in English | MEDLINE | ID: covidwho-958033

ABSTRACT

BACKGROUND: During the first wave of the COVID-19 pandemic, German health care centres were restructured for the treatment of COVID-19 patients. This was accompanied by the suspension of the surgical programme. The aim of the survey was to determine the effects of COVID-19 on surgical care in non-university hospitals in Germany. METHODS: This cross-sectional study was based on an anonymous online survey, which was accessible from April 24th to May 10th, 2020 for surgeons of the Konvent der leitenden Krankenhauschirurgen (Convention of leading Hospital Surgeons) in Germany. The analysis comprised of 22.8% (n = 148/649) completed surveys. RESULTS: Communication and cooperation with authorities, hospital administration and other departments were largely considered sufficient. In the early phase of the COVID-19 pandemic, 28.4% (n = 42/148) of the respondents complained about a short supply of protective equipment available for the hospital staff. 7.4% (n = 11/148) of the participants stated that emergency operations had to be postponed or rescheduled. A decreased quantity of emergency surgical procedures and a decreased number of surgical emergency patients treated in the emergency room was reported in 43.9% (n = 65/148) and 63.5% (n = 94/148), respectively. Consultation and treatment of oncological patients in the outpatient clinic was decreased in 54.1% (n = 80/148) of the surveyed hospitals. To increase the capacity for COVID-19 patients, a reduction of bed and operating room occupancy of 50.8 ± 19.3% and 54.2 ± 19.1% were reported, respectively. Therefore, 90.5% (n = 134/148) of all participants expected a loss of revenue of 28.2 ± 12.9% in 2020. CONCLUSION: The first wave of the COVID-19 pandemic had a significant impact on surgical care in Germany. The reduction in the bed and the operating room capacity may have lead to considerable delays in urgent and semi-elective surgical interventions. In addition to the risk of worsening patient care, we anticipate severe financial damage to the clinics in 2020 and beyond. National and supranational planning is urgently needed to ensure the surgical care of patients during the ongoing COVID-19 pandemic.


Subject(s)
Surgery Department, Hospital/organization & administration , Surgical Procedures, Operative/statistics & numerical data , Cross-Sectional Studies , Germany , Hospital Bed Capacity , Hospitals , Humans , Pandemics
12.
Int J Surg ; 84: 57-65, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-893960

ABSTRACT

BACKGROUND: Two million non-emergency surgeries are being cancelled globally every week due to the COVID-19 pandemic, which will have a major impact on patients and healthcare systems. METHODS: During the peak of the pandemic in the United Kingdom, we set up a multicentre cancer network amongst 14 National Health Service institutions, performing urological, thoracic, gynaecological and general surgical urgent and cancer operations at a central COVID-19 cold site. This is a cohort study of 500 consecutive patients undergoing surgery in this network. The primary outcome was 30-day mortality from COVID-19. Secondary outcomes included all-cause mortality and post-operative complications at 30-days. RESULTS: 500 patients underwent surgery with median age 62.5 (IQR 51-71). 65% were male, 60% had a known diagnosis of cancer and 61% of surgeries were considered complex or major. No patient died from COVID-19 at 30-days. 30-day all-cause mortality was 3/500 (1%). 10 (2%) patients were diagnosed with COVID-19, 4 (1%) with confirmed laboratory diagnosis and 6 (1%) with probable COVID-19. 33/500 (7%) of patients developed Clavien-Dindo grade 3 or higher complications, with 1/33 (3%) occurring in a patient with COVID-19. CONCLUSION: It is safe to continue cancer and urgent surgery during the COVID-19 pandemic with appropriate service reconfiguration.


Subject(s)
/mortality , Hospital Mortality , Oncology Service, Hospital/organization & administration , Surgery Department, Hospital/organization & administration , Adult , Aged , Cohort Studies , Female , Humans , Male , Middle Aged , Pandemics , Postoperative Complications/epidemiology , State Medicine , United Kingdom/epidemiology
13.
Acta Biomed ; 91(3): e2020027, 2020 09 07.
Article in English | MEDLINE | ID: covidwho-761243

ABSTRACT

In order to continue the oncological surgical activity and the surgical emergencies, we have elaborated a reorganization of the surgical department. In particular, differentiated pathways for COVID-19 and NON-COVID-19 patients were promptly planned. This arrangement has involved structural and organizational changes almost daily, with great efforts of the health personnel, but allowing our hospital to be the only one in the area still able to guarantee patients safe access to surgical treatment.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Disease Outbreaks , Emergencies , Hospitals, Teaching/organization & administration , Pneumonia, Viral/epidemiology , Surgery Department, Hospital/organization & administration , Comorbidity , Humans , Italy/epidemiology , Pandemics
14.
Updates Surg ; 72(4): 1263-1271, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-756675

ABSTRACT

Surgical site infections are the most common in-hospital acquired infections. The aim of this study and the primary endpoint is to evaluate how the measures to reduce the SARS-CoV-2 spreading affected the superficial and deep SSI rate. A total of 541 patients were included. Of those, 198 from March to April 2018, 220 from March till April 2019 and 123 in the COVID-19 era from March to April 2020. The primary endpoint occurred in 39 over 541 patients. In COVID-19 era, we reported a lower rate of global SSIs (3.3% vs. 8.4%; p 0.035), few patients developed a superficial SSIs (0.8% vs. 3.4%; p 0.018) and none experienced deep SSIs (0% vs. 3.4%; p 0.025). Comparing the previous two "COVID-19-free" years, no significative differences were reported. At multivariate analysis, the measures to reduce the SARS-CoV-2 spread (OR 0.368; p 0.05) were independently associated with the reduction for total, superficial and deep SSIs. Moreover, the presence of drains (OR 4.99; p 0.009) and a Type III-IV of SWC (OR 1.8; p 0.001) demonstrated a worse effect regarding the primary endpoint. Furthermore, the presence of the drain was not associated with an increased risk of superficial and deep SSIs. In this study, we provided important insights into the superficial and deep SSIs risk assessment for patients who underwent surgery. Simple and easily viable precautions such as wearing surgical masks and the restriction of visitors emerged as promising tools for the reduction of SSIs risk.


Subject(s)
/prevention & control , Infection Control , Surgery Department, Hospital/organization & administration , Surgical Wound Infection/prevention & control , Adult , Aged , Female , Humans , Italy/epidemiology , Male , Middle Aged , Pandemics , Prevalence , Prognosis , Retrospective Studies , Risk Factors , Surgical Wound Infection/epidemiology
16.
Medicine (Baltimore) ; 99(32): e21548, 2020 Aug 07.
Article in English | MEDLINE | ID: covidwho-705597

ABSTRACT

Novel coronavirus disease (COVID-19) emerged in Wuhan in December 2019, has spread in many countries affected people globally. In response to the economic requirement of the nation and meet the need of patient's, a momentous event was going back to work step by step as fighting against COVID-19. Safety in clinical work is of priority as elective surgery in the department of surgery progressing. We used checklists based on our experiences on COVID-19 control and reality of clinical work from February to March in the West China Hospital, involving events of screening patient, chaperonage, and healthcare workers. Checklist summarized the actual clinical nursing work and management practices, hope to provide a reference for the order of surgery during the epidemic prevention and control, and standardize the clinical nursing work of surgery during pandemic.


Subject(s)
Checklist/methods , Coronavirus Infections/prevention & control , Elective Surgical Procedures/methods , Infection Control/organization & administration , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Vascular Surgical Procedures/organization & administration , Chi-Square Distribution , China , Coronavirus Infections/epidemiology , Female , Humans , Male , Medical Staff, Hospital , Occupational Health , Outcome Assessment, Health Care , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Surgery Department, Hospital/organization & administration
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